Measures of disease Frequency

Associate Professor Bao-zhu Li

Department of Epidemiology and Biostatistics
Anhui medical university
 Patient Profile
 A 72-year-old man presents with slowly progressive urinary frequency, hesitancy, and
dribbling.

 A digital rectal examination reveals a symmetrically enlarged prostate gland and no

nodules.

 Urinary flow measurements show a reduction in flow rate, and his serum prostate
specific antigen (PSA) is not elevated.

 The clinician diagnoses benign prostatic hyperplasia (BPH).

2
 Clinical background
 In deciding on treatment, the clinician and patient must weigh the benefits and
hazards of various therapeutic options.

 To simplify, let us say the options are medical therapy with drugs or surgery.

 The patient might choose medical treatment but runs the risk of worsening
symptoms or obstructive renal disease because the treatment is less
immediately effective than surgery.

 Or he might choose surgery, gaining immediate relief of symptoms but at the

risk of operative mortality and long-term urinary incontinence and impotence.

3
• Decisions such as the one this patient and clinician face have traditionally relied
on clinical judgment based on experience at the bedside and in the clinics.
• In modern times, clinical research has become suffciently strong and extensive
that it is possible to ground clinical judgment in research-based probabilities—
frequencies.
• Probabilities of disease, improvement, deterioration, cure, side effects, and
death are the basis for answering most clinical questions.
• For this patient, sound clinical decision making requires accurate estimates of
how his symptoms and complications of treatment will change over time
according to which treatment is chosen.

4
 ARE WORDS SUITABLE
SUBSTITUTES FOR NUMBERS?
 Medicine isn’t an exact science, uncertainty is ever present.

 Clinicians often communicate probabilities as words (e.g., usually, sometimes,

rarely) rather than as numbers.

 Substituting words for numbers is convenient and avoids making a precise

statement when one is uncertain about a probability. However, words are a poor
substitute for numbers because there is little agreement about the meanings of
commonly used adjectives describing probabilities.

5
 Physicians were asked to assign percentage values to 13 expressions of
probability. These physicians generally agreed on probabilities corresponding to
adjectives such as “always” or “never” describing very likely or very unlikely
events but not on expressions associated with less extreme probabilities.

 For example, the range of probabilities (from the top to the bottom tenth of
attending physicians) was 60% to 90% for “usually,” 5% to 45% for sometimes,
and 1% to 30% for “seldom.” This suggests that difference of opinion among
physicians regarding the management of a problem may reflect differences in the
meaning ascribed to words used to define probability” .

6
 1. Rates, Ratios and proportions compared 7

与紫杉醇或卡铂单独使用相比，紫杉醇 + 卡铂（ PC ）联
• In epidemiology, many nominal variables have only two possible
合使用对于治疗卵巢癌的疗效和安全性如何？
categories: alive or dead; case or control; exposed or unexposed. Such
variables are called dichotomous variables.
 Measuring disease occurrence
counts
number of cases
“we have 5 cases of tetanus”

On its own very little informative!!

Who is in the denominator ????
In what time period did they occur???

8
Measuring disease occurrence
Proportion
Ratio
Rate

What, who is in the denominator ????

In what time period did they occur???

9
 Proportion
• A proportion is an expression in which the numerator is always
included in the denominator.
与紫杉醇或卡铂单独使用相比，紫杉醇 + 卡铂（ PC ）联
• The division of 2 numbers
合使用对于治疗卵巢癌的疗效和安全性如何？
• Numerator Is a segment of denominator
• In general, Numerator and denominator are of the same nature(quantities)
• In general, ranges between 0 and 1
• Percentage = proportion x 100

males
population
= 400 / 1000 = 40%

10
 Ratio
• A ratio is the value obtained when dividing one quantity by another.
• Numerator IS NOT a segment of the denominator
• Allows to compare quantities of different nature

males
= 5 / 2 = 2.5 /1
females
beds
= 850 / 10 = 85 / 1
doctors
participants
= 3/1
facilitators

11
 Rate
• A rate measures the occurrence of some particular event during a
given time period in a population at risk.

Number of cases or events occurring during a given time period

* k
Population at risk during the same time perod

measles in 2007
= 2000 / 15 000 000 =
Population in 2007

= 0.00013 = 1.3 per 10,000 inhabitants per year

12
 2. Morbidity Frequency Measures 13

• Incidence rates
• An incidence
与紫杉醇或卡铂单独使用相比，紫杉醇 + 卡铂（
rate is a measure of the frequency PC ）联
with which an event,
such as a new case of illness, occurs in a population over a period of
合使用对于治疗卵巢癌的疗效和安全性如何？
time.
new cases ocurring during a given time period
Incidence rate =
* k
population at risk during the same time period

• Usage: short-term, communicable acute diseases (cholera, measles)or

chronic or long-term conditions (cancer, diabetes mellitus)
 Incidence rates

Notice
与紫杉醇或卡铂单独使用相比，紫杉醇 + 卡铂（ PC ）联
•The numerator of an incidence rate should reflect new cases of disease
合使用对于治疗卵巢癌的疗效和安全性如何？
that occured or were diagosed during the specified period, instead of
cases that occurred or were diagosed earlier.

•The denominator should accurately reflect the numbers at risk or under

study in the group or population. This means that persons who are
included in the denominator should be able to develop the disease that is
being described during the time period covered. eg: uterine cancer.

14
 Incidence rates

Notice
与紫杉醇或卡铂单独使用相比，紫杉醇 + 卡铂（ PC ）联
•Unfortunately, unless we conduct a special study, we usually cannot
合使用对于治疗卵巢癌的疗效和安全性如何？
identify and eliminate persons who are not susceptible to the disease
from available population data.

•In practice, the most feasible denominator will often be the average size
of the population over the time period or the size of the population (either
total or at risk) at the middle of the time period.

15
 The occurrence of acute infectious diseases in a city
District number annual average po cases the ratio of cases between other proportion (%) incidence
(1) pulation (3) Districts and district I (5) rate
(2) (4) (1/100000)
(6)
I 636723 2433 - 18.9 382
II 389540 3033 1.25 23.5 779
III 699712 1650 0.68 12.8 236
IV 328363 1503 0.62 11.6 458
V 286967 1282 0.53 10.0 447
VI 317504 1853 0.76 14.4 584
VII 143838 1130 0.46 8.8 786
Total 2802647 12884 100.0 460

16
 Cumulative incidence(CI)

• CI is the proportion of people who become diseased over a specified

与紫杉醇或卡铂单独使用相比，紫杉醇
length of time. + 卡铂（ PC ）联
合使用对于治疗卵巢癌的疗效和安全性如何？
• CI is estimated only for the first occurrence of the disease; thus, the
candidate population consists of disease-free subjects at the beginning
of the follow-up period or upon inclusion in the study.

• If the durations of the individual follow-up periods for all non-cases are
equal, the CI is equivalent to the average risk for members of the
cohort (a group that is followed over time).

17
 Cumulative incidence
• In practice, however, this special condition seldom occurs because of
losses (due to deaths or withdrawals) from the study population.
与紫杉醇或卡铂单独使用相比，紫杉醇
However, + 卡铂（
if the cohort is fixed and there is little attritionPC ）联the
during
follow- up period, the Cl can be estimated as follows:
合使用对于治疗卵巢癌的疗效和安全性如何？
CI=I / N'0
• I is the number of new cases diagnosed during the period
• ‘N'0’ is the number of disease-free subjects at the beginning of the
period.
• This measure is a proportion, because all persons in the numerator are
also in the denominator. It is a measure of the probability or risk of
disease, i.e., what proportion of the population will develop illness
during the specified time period.
• The cumulative incidence rate varies from 0 to 1 (or 0-100 ( percent).
18
 Attack rates
• An attack rate is actually a measure of risk (usually expressed in
percentage), used for exposed populations observed for limited
periods of time.
• It is seldom measured in periods of more than a few months.
• Attack rates are used in analyzing epidemics in which smaller selected
populations are exposed to some disease or injury-causing event such
as food poisoning, chemical exposures or environmentally related
occurrences.
• For example, we might speak of an influenza epidemic with an attack rate of
10%, Which means that 10% of the population developed the disease during
the epidemic period.

19
 Secondary attack rates
• Secondary attack rates are measures of risk that are typically used in
infectious disease investigations involving a pathogen with a short
incubation period.
• The secondary attack rate is often used when the cases of an illness
occur in the same household or work group, and when a primary case
of the disease presents before others in the group that get the disease.

Number of cases among contacts of

Secondary attack rate = primary cases during the period xK
Total number of susceptible contacts

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 Secondary attack rates
• Cases that develop in the group following exposure to the primary case
of infection are considered secondary cases and form the numerator of
the measure.

• The numbers of persons who had contact with or exposure to the

primary infectious person or the primary source of infection within the
incubation period of the pathogen make up the denominator in
calculating the rate.

• The denominator excludes individuals, who have previously had the

disease and now are immune, or who have had immunizations;
susceptible people are the only ones used in the denominator.

21
 Secondary attack rates
• Example
• Seven cases of hepatitis A occurred among 70 children attending a
child care center. Each infected child came from a different family. The
total number of persons in the 7 affected families was 32. One
incubation period later, 5 family members of the 7 infected children
also developed hepatitis A.

• Question: how to calculate secondary attack rate?

22
 Secondary attack rates
• Example
• Seven cases of hepatitis A occurred among 70 children attending a
child care center. Each infected child came from a different family. The
total number of persons in the 7 affected families was 32. One
incubation period later, 5 family members of the 7 infected children
also developed hepatitis A.

• Numerator = cases hepatitis A among family contacts of children with

hepatitis A = 5
• Denominator = number of persons at risk in the families (total number
of family members-children already infected) = 32-7 = 25
5
Secondary attack rate = x 100% = 20%
25 23
 Prevalence
• prevalence is the proportion of persons in a population who have a
particular disease or attribute at a specified point in time or over a
specified period of time.

• In the medical and public health literature, the word prevalence is often
used in two ways: point prevalence and period prevalence.

24
 Prevalence
• point prevalence is the proportion of individuals within a population
who have a disease, condition or illness at a specific point in time.

number of existing cases of the disease

point prevalence= at appoint in time x k
total study population

• For example, in a visual examination survey conducted in Framingham,

Massachusetts, USA, among individuals 52-85 years of age, 310 of the 2,477
persons examined had cataracts at the time of the survey. The prevalence of cataract
in that age group was therefore 310 per 2,477 or 12.5 percent.
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 Prevalence
• Period prevalence It measures the frequency of all current cases of disease in a
specified period of time. When we want to know how much a particular disease
is present in a population over a longer period, we use period prevalence rate.
• It includes point prevalence at the beginning of the time period plus all new
cases that occur within the time period.

number of existing cases of the disease

point prevalence= at appoint in time x k
total study population
• For example, the 12 month period prevalence of low back pain in a sample of British
men aged 30-39 was found to be 33.6%. Thus, just over one third of these women
experienced low back pain at some time over the course of a year.
26
 Comparative factors affecting prevalence measu
res
Measures are increased by
Immigration of ill cases
Emigration of healthy persons
Immigration of susceptible cases or those
with potential of becoming cases
Prolongation of life of cases without cure (i
ncrease of duration of disease)
Increase in occurrence of new cases (increa
se in incidence)
Measures are decreased by
Immigration of healthy persons
Emigration of ill cases
Improved cure of cases
Increased case fatality from the diseases
Decrease in occurrence of new case
Shorter duration of disease
Decrease in occurrence of new cases(disea
se in incidence)
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 The interrelationship between incidence and prevalence
• prevalence (P) is proportional to the product of the incidence rate
(I) and the average duration of the disease (D).

• In particular, in the stable situation referred to as “steady state,”

meaning that the incidence rate of the disease has been constant
over time (i.e., no epidemic or marked reduction of the disease), as
well as the the distribution of the duration the disease (i.e., no
major change in the length of time from diagnosis to recovery or
death), and assuming that the prevalence of the disease in the
population is low (i.e., less than 0.1), the prevalence is
approximately equal to the product of "I” and "D" as expressed by
the formula
P=I*D
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 The interrelationship between incidence and prevalence
• When two of the measures are known, the third can be calculated
simply by substitution.

• For example, the average annual incidence rate of epilepsy in

Minnesota was 30.8 per 100,000, and the average annual prevalence
was 376 per 100,000. Therefore, the average duration of epilepsy
could be estimated as follows:

D=P/I=376 per 100,000/30.8 per 100,000=12.2 year

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30
 Comparison of incidence and prevalence

• Incidence helps to elucidate causal factors when the focus is the explanation
of the occurrence of illness.
• The measure that is most descriptive of occurrence is the incidence rate.
• Causal factors necessarily operate prior to the onset of disease, and for acute
illnesses the closer in time to disease onset that incidence are measured, the
more directly it will reflect the operation of causal factors and be useful for
studies of causation.
• For chronic diseases such as cancer, however, causal factors may be most
relevant many years before disease onset.

31
 Comparison of incidence and prevalence

• Prevalence When incidence rates are not obtainable, patterns in prevalence

proportions may give clues as to possible variations in incidence.
• A main value of prevalence data is in administrative situations requiring
knowledge of how many patients with a given disease exist in the community.
• Incidence rate may be of less value in such situations because, for a given
incidence diseases of long duration usually impose a greater burden on the
community than those of short duration.

32
 Characteristics of incidence and prevalence

Characteristic Incidence Prevalence (point prevalence)

New cases occurring during a peri

All cases counted on a single su
Numerator od of time among a group initially
rvey or examination of a group
free of disease
All susceptible people present at th All people examined, including
Denominator
e beginning of the period cases and non-cases
Time Duration of the period Single point
What is measur Percentage of population with
Rapidity of disease occurrence
ed disease
Cohort study, population-based s
Prevalence (cross-sectional) st
How measured urveillance of death or specific dise
udy
ases (cancer registries, etc.)
33
 Practice

• A company has 500 people. Among these people, 20 of them got a disease
from 2010 to 2012. 5 out of 500 people became ill before the beginning of
2010. Patients can obtain lasting immunity after the disease. In this three
years the incidence of the disease is shown in figure.
• Question 1: According to the information in the figure ， please
calculate the incidence, period prevalence and point prevalence of
disease in the three years.
• Question 2: What are the differences between the prevalence and
incidence? Describe the significance of prevalence and incidence in
epidemiological studies.
• Question 3: In this example, why we calculate the incidence rate
instead of the attack rate?
34
2010 2011 2012

onset recovery death

The onset of a disease in a population, 2010-2012

35
 Infection rates
• Infection rate is the number of subjects infected with a pathogen
与紫杉醇或卡铂单独使用相比，紫杉醇
(living + 卡铂（
with disease) divided by the total number PC ）联
of subjects within
a given time period.
合使用对于治疗卵巢癌的疗效和安全性如何？
Number of subjects infected
Infection rate =
Number of total subjects
* k

• Infection rate is helpful for evaluating the effect of preventive

measures, and commonly used as an indicator of overall
population health status, and the status of certain infectious or
parasitic infections. It is particularly applicable to latent infections
such as tuberculosis, pathogen carriers, and rare or atypical cases.
36
 3. Mortality Frequency Measures 37

• Mortality rates
• Mortality
与紫杉醇或卡铂单独使用相比，紫杉醇 卡铂（ PCof）联
rate is a measure of the frequency of+occurrence death in a
defined population during a specified interval, in other words, it is the
合使用对于治疗卵巢癌的疗效和安全性如何？
incidence rate of death for a defined population, over a specified period
of time.

Deaths occurring during a given time period

Mortality rate *k
= Size of the population among which the deaths occurred

• When mortality rate is based on vital statistics (e.g., counts of death

certificates), the denominator most commonly used is the size of the
population at the middle of the time period.
 Mortality rates

• Death rates are sometimes used as surrogates of incidence.

与紫杉醇或卡铂单独使用相比，紫杉醇 + 卡铂（ PC ）联
• Routine registration of deaths, together with the specification of cause
合使用对于治疗卵巢癌的疗效和安全性如何？
of death, enables death rate to be derived for many diseases and
among many populations for which more direct measures of incidence
are not available.
• Death rates are most useful as surrogates of incidence when the
relationship between incidence and mortality is well known
• For example, for conditions such as lung cancer where case fatality is
high and interval between onset of illness and death is short.

38
 Crude mortality rate

• is the morality rate from all causes of death for a population.

与紫杉醇或卡铂单独使用相比，紫杉醇 + 卡铂（ PC ）联
• The term “crude” refers to rates that are based on cases occurring in
the 合使用对于治疗卵巢癌的疗效和安全性如何？
total observed population, without statistical adjustment for any
demographic subgroups of the population.
• Crude rates in two populations may differ because of a real difference
in disease rates or because of differences in the composition of the two
populations, eg, age, sex.

39
 Specific mortality rates

• Specific refers to rates that are limited to individuals having the

与紫杉醇或卡铂单独使用相比，紫杉醇
characteristics specified. + 卡铂（ PC ）联
• Cause-specific
合使用对于治疗卵巢癌的疗效和安全性如何？
mortality rate A death rate that pertains to death from
a specific cause or source. The numerator is deaths from a certain
disease for a certain time period, and the denominator is the
corresponding population for the same time period.
• Age-specific mortality rate An age-specific mortality rate is a mortality
rate limited to a particular age group. The numerator is the number of
deaths in that age group; the denominator is the number of persons in
that age group in the population.

40
 Specific mortality rates

• Sex-specific mortality rate A sex-specific mortality rate is a mortality rate

among 与紫杉醇或卡铂单独使用相比，紫杉醇 卡铂（
either males or females. Both numerator +and PC ）联are
denominator
limited to one sex.
合使用对于治疗卵巢癌的疗效和安全性如何？
• Rate for other specified characteristics or combinations of characteristics
Mortality rate for any specific disease such as heart disease, can be
presented for subgroups defined by age, race ,gender, religion ,etc ,as well
as for combinations of characteristics , such as age and sex.

41
 Adjusted Rates

• Adjusted rates use mathematical calculations and transformations

to 与紫杉醇或卡铂单独使用相比，紫杉醇
allow valid comparisons among populations + 卡铂（
having PC ）联
characteristics or traits that may affect risk of injury, disease,
合使用对于治疗卵巢癌的疗效和安全性如何？
disability, or death.

42
 Adjusted Rates
Direct method of age adjustment
•For this method one first calculates the rates for subjects in each
与紫杉醇或卡铂单独使用相比，紫杉醇
specific age stratum in a study population. + 卡铂（ PC ）联
•These合使用对于治疗卵巢癌的疗效和安全性如何？
age-specific rates are then applied to a “standard
population”(for example, the United States population in the year
2000 , or a “world standard population” specified by World Health
Organization) to estimate what the crude incidence rate in this
standard population would be if it experienced the same age-specific
rate as those seen in the study population.
•This calculated rate then constitutes the age-adjusted rate for the
study population.
•Using this process, one then can compare the rates for two or more
study populations while accounting for the differences in the age
structures of the different populations. 43
 Adjusted Rates
Indirect method
•Indirect adjustment is preferred over direct adjustment if the
与紫杉醇或卡铂单独使用相比，紫杉醇
numbers + 卡铂（are
in specific age groups in the study population PCtoo）联small
to permit precise estimation of age-specific rates.
合使用对于治疗卵巢癌的疗效和安全性如何？
•In indirect standardization , the observed age-specific rates of the
condition under study for a standard population are used to estimate
the “expected” number of cases (or deaths) that would have occurred
in the study population if it experienced the sam age-specific rates as
the standard population .
•Dividing the observed number of cases by the expected number
produces a standardized incidence ratio(SIR) or standard mortality
ratio(SMR).
• Standardized mortality ratio=Observed death/Expected death
44
 Infant mortality rate

• Infant mortality rate is the number of deaths of infants(one year of

age与紫杉醇或卡铂单独使用相比，紫杉醇
or younger) Per 1,000 live births. + 卡铂（ PC ）联
• Currently
合使用对于治疗卵巢癌的疗效和安全性如何？
the more common causes of infant mortality are
pneumonia, congenital malformation and other infections.
• Infant mortality rate in commonly included as a part of standard of
living evaluations in economics.

45
 Neonatal mortality rate

• Neonatal mortality rate is defined as the number of deaths during

the与紫杉醇或卡铂单独使用相比，紫杉醇 + 卡铂（
first 28 completed days of life per 1,000 live PC
births in ）联
a given
year.
合使用对于治疗卵巢癌的疗效和安全性如何？
• Neonatal deaths account for a large proportion of child deaths.
• Mortality during the neonatal period is considered a good indicator
of both maternal and newborn health care.

46
 Under-five mortality rate

• Under-five mortality rate, or child mortality rate, is the probability

与紫杉醇或卡铂单独使用相比，紫杉醇
that a newborn baby will die before reaching + 卡铂（
the five）联
age ofPC , if
subject to current age-specified mortality rates.
合使用对于治疗卵巢癌的疗效和安全性如何？
• The probability is expressed as a rate per 1,000.
• Under-five mortality rate and infant mortality rate are leading
indicators of the level of child health and overall development in
many countries.

47
 Maternal mortality rate

• Maternal mortality rate is the number of maternal deaths related to

与紫杉醇或卡铂单独使用相比，紫杉醇
childbearing + 卡铂（
divided by the number of live births in thatPC ）联
year .
• According
合使用对于治疗卵巢癌的疗效和安全性如何？
to the WHO, “A maternal death is defined as the death of
a woman while pregnant or within 42 days of termination of
pregnancy, inspective of the duration and site of pregnancy, from
any cause related to or aggravated by the pregnancy or its
management but not from accidental or incidental causes.”
• Generally there is a distinction between a direct matemal death that
is the result of a complication of the pregnancy , delivery , or their
management ; and an indirect maternal death is a pregnancy-
related death in a patient with a preexisting or newly-developed
health problem.
48
 Case fatality
• The propensity of a disease to cause the death of affected patients is
referred to as the case fatality.

Case fatality(%)=Number of deaths/Number of diagnosed patients x k

• the population at risk is those who have already developed from the
disease.
• The event being measured is not the development of the disease but
death converted to a percentage.

49
 Survival rate
• Survival rate is the probability of staying alive for a specific length of
time. For a chronic disease such as cancer, 1-year survival and 5-year
survival are often used as indicators of the severity of disease and
prognosis.

Survival rate(%)=(A-D)/A * k
• “D”is the number of deaths observed in a specified period of time.
• “A”is the number of newly diagnosed patients under observation.
• Calculation of survival indicates the probability of surviving a specified
length of time and is inversely related to the risk of death. Survival
estimates provide a useful way to summarize prognosis.

50
 Potential years of life lost (PYLL)
• PYLL is a public health concept reflecting human and economic
implications of the loss of individuals in a society due to a health
condition, a hazardous exposure,or lack of an intervention (eg,
immunization).
• A 20-year-old young man who dies in an automobile accident due to
drinking and driving could theoretically have lived to average life
expectancy of 72 years; thus 52 years of life are lost. When 2,000
deaths like this occur, 104,000 potential years of life are lost.
• This life that was lost is a waste to society as it could have been
prevented.

51
 Disability adjusted life years (DALY)
• DALY for a disease are the sum of the years of life lost due to
premature mortality (YLL) in the population plus the estimated years
that are effectively lost due to disability (YLD) for incident cases of the
health condition.
• The YLD is based on an estimate of the reduced quality of life resulting
from the disability; for example, spending the last ten years of one’s
life as a quadriplegic following a spinal injury might be viewed as
equivalent to only three years of healthy life, thus, an estimated seven
DALYs have been lost.
• The DALY is a health gap measure that extends the concept of potential
years of life lost due to premature death to include equivalent years of
“healthy” life lost in states of less than full health, broadly termed
disability. One DALY represents the loss of one year of equivalent full
health. 52
 53

Epidemiology is the study of the distribution and determinants

of disease frequency in human population.
Epidemiology: Principles and Methods

by Brian MacMahon

1996

53
 54

The distribution of
Disease considers

Who is getting disease?

Where is disease occurring?
When is disease occurring?
54
 Distribution of Diseases 55

• In descriptive epidemiology, we organize and summarize data according

与紫杉醇或卡铂单独使用相比，紫杉醇
to person, + 卡铂（
time, and place. Compiling and analyzing ）联
PCthese
data by
characteristics is desirable for several reasons.
合使用对于治疗卵巢癌的疗效和安全性如何？
• First, the investigator becomes intimately familiar with the data and with
the extent of the public health problem being investigated.
• Second, these data provide a detailed description of the health of a
population that can be easily communicated.
• Third, such analyses identify the populations that are at greatest risk of
acquiring a particular disease and thus may provide important clues that
can lead to testable hypotheses about the causes of the disease.
 Person

• When organizing or analyzing data by personal characteristics, inherent

与紫杉醇或卡铂单独使用相比，紫杉醇
descriptors(for example, age, race, sex), acquired + 卡铂（ PC ）联
characteristics
(immune or marital status), activities (occupation, leisure activities, use
合使用对于治疗卵巢癌的疗效和安全性如何？
of medications/tobacco/drugs), or economic conditions(socioeconomic
status, access to medical care) may an be considered.
• These factors often determine to a large degree that is at greatest risk
of experiencing some undesirable health condition, such as infection
with a particular disease organism. Often we analyze data for more than
one category simultaneously; for example, we may look at age and sex
together to see if the sexes differ with regard to the age at onset of a
condition-as is seen for heart disease

56
 Person
Sex
与紫杉醇或卡铂单独使用相比，紫杉醇
•Males have 卡铂（ for
higher rates of disease and death than+females PCa）联
wide
range of conditions.
合使用对于治疗卵巢癌的疗效和安全性如何？
•For some diseases, genetic, hormonal, anatomic, or other inherent
differences between the sexes affect their susceptibility or physiologic
responses.
•For example, premenopausal women have a lower risk of heart disease
than men of the same age, a difference that is possibly due to their higher
estrogen levels. On the other hand, the sex-related differences in the
occurrence of many diseases, such as the higher risk of occupational lung
disease(pneumoconiosis) in men, reflect differences in opportunity or
levels of exposure.
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 Person
Age
与紫杉醇或卡铂单独使用相比，紫杉醇
•The increases + 卡铂（
in disease morbidity with age are more PC ）联
apparent than for
any other variable.
合使用对于治疗卵巢癌的疗效和安全性如何？
•The effects of age are often ascribed to an individual’s cumulative
exposure to environmental insults(e.g. chemical, socio-cultural, or lifestyle
exposures) over a life span or to the effects of physiological/hormonal
factors(as with breast cancer, for example).
•The processes of aging(e.g. declining immunological defenses and
increasing numbers of mutations in cells) are commonly invoked as
possible mechanisms in their own right, and some investigators argue
that there is no evidence that ageing itself causes disease.

58
 Person
Ethnic and racial groups
与紫杉醇或卡铂单独使用相比，紫杉醇
•In examining epidemiologic data, people who have 卡铂（
+ lived PC ）联
together long
enough to acquire common characteristics, either biologically or socially,
may be of合使用对于治疗卵巢癌的疗效和安全性如何？
interest.
•Several terms are commonly used to define such groups: race,
nationality, religion, or social groupings such as tribes and other
geographically or socially isolated groups.
•Differences in disease risk by race, ethnicity, or other groupings may
reflect differences in susceptibility, exposure, or factors such as
socioeconomic status and access to health care.

59
 Person
Marital status
与紫杉醇或卡铂单独使用相比，紫杉醇
•Often there 卡铂（ PC
are major differences in disease rates+according to ）联
marital
status: married persons generally have lower death rates than single
persons,合使用对于治疗卵巢癌的疗效和安全性如何？
but the true causes of the association may be difficult to explain.

•The main difficult arises in determining whether being married offers

health advantages, or whether characteristics of good health or long life
favor an individual’s predisposition to marriage.

60
 Person
Socioeconomic status
•income,与紫杉醇或卡铂单独使用相比，紫杉醇 卡铂（
occupation, living conditions, education, +and PCto）联
access services.
•The frequency of many adverse health conditions, such as tuberculosis,
合使用对于治疗卵巢癌的疗效和安全性如何？
increases with decreasing socioeconomic status. Infant mortality and time
lost from work due to disability are both associated with lower income.
These patterns may reflect more harmful exposures, lower resistance, and
less access to untangle.
•Some adverse health conditions, including breast cancer, Kawasaki
syndrome, and tennis elbow, are more frequent among persons of higher
socioeconomic status.

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 Time
• Diseases differ by time refers to the distribution of given disease by
hours, days, weeks, months, years, or even by decades.
• Short-term fluctuation refers to relatively brief, unexpected increases in
the frequency of a particular disease. Short-term fluctuations are
commonly manifested in epidemics.
• Cyclic trends represent periodic increase in frequency of a particular
disease morbidity or mortality. It often is predicable. For example,
measles, before the wide use of vaccine for the immunization,
epidemics were common at two or three years intervals.
• Seasonal variation is a typical cyclic pattern. For example, diarrheal
disease is most common during the summer, and respiratory disease is
most common during the winter.
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 Place
• we describe a health event by place to gain insight into the
geographical extent of the problem.
• For place, we may use place of residence, birthplace, place of
employment, school district, hospital unit, etc., depending on which
may be most closely related to the occurrence of condition.
• Similarly, we may use large or small geographic units: country, state,
county, census tract, street address, map coordinates, or some other
standard geographical designation.
• Sometimes, we may find it useful to analyze data according to place
categories, such as urban or rural, domestic or foreign, and institutional
or non-institutional.

63
 Migrant studies
• By comparing populations of similar genetic background that are living
in different physical and social environments, migrant studies can
provide useful insights into the relative importance of environment and
genetics in disease etiology.

• Rate of disease in migrants(Rm1) versus that of the population from

which they originated(R0), or rates in migrants versus those of
residents of the new host country in which they have settled(Rh).

• If Rm1 is close to R0 and different form Rh, we may conclude that

genetic factors contribute most to disease etiology; otherwise,
environmental factors may appear to play an important role for the
disease.
64
• Cancer registries report 40 new cases of bladder cancer per 100,000
men per year. Cases were from a complete count of all patients who
developed bladder cancer in several regions of the United States, and
the number of men at risk was estimated from the census data in those
regions. Which rate is this an example of?
A. Point prevalence
B. Period prevalence
C. Incidence density
D. Cumulative incidence
E. Complication rate

65
• Sixty percent of adults in the U.S. population have a serum cholesterol
>200mg/dL (5.2 mmol/L). Which rate is this an example of?
A. Point prevalence
B. Complication rate
C. Incidence density
D. Cumulative Incidence
E. Period prevalence

66
• The incidence of rheumatoid arthritis is about 40/100,000/year and the
prevalence is about 1/100 persons. On average, how many years does
the disease persist?
A. 10
B. 25
C. 33
D. 40
E. 50

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Thank you for listening